Neurodegenerative Disease Soaring Across China
Neurodegenerative disease is now the fastest-growing cause of death around the world. Many factors are contributing to the surge, including misinformation, disinformation and reckless public policies.
The number of individuals with dementia in China, for example, is the highest in the world and is increasing rapidly. According to a nationwide study in 2020, the prevalence of dementia among people aged 60 years and above in China is 6.0 percent. The prevalence of Alzheimer’s disease is 3.9 percent.
The prevalence of Alzheimer’s disease and dementia increased substantially between 1990 and 2010. The information available in the Chinese scientific literature is sufficient to generate precise estimates of the prevalence of Alzheimer’s disease and other forms of dementia in China over the past two decades.
China’s population has rapidly aged over the recent decades and neurodegenerative disorders are soaring, especially Alzheimer’s disease (AD) and related dementias (ADRD). AD’s incidence rate, morbidity, and mortality have steadily increased to make it the fifth-leading cause of death among urban and rural residents in China.
The surge in Alzheimer’s disease is is compounding the financial burdens on individuals, families and society.
The China Alzheimer Report 2022 compares China’s socioeconomic information and the status of healthcare provisions associated with dementia. Compared with the annual World Alzheimer Report, this report gives a detailed picture of ADRD within China, including epidemiological data and information on the diagnosis, treatment and public resources available for the care of those with AD. This paper is commissioned by the China AD report editorial board and includes the work of many highly respected researchers in China. It is an important source of information both within China and globally.
The data suggests that the true burden of disease in China is double the estimates used by Alzheimer’s Disease International for China and east Asia. The data suggests that global estimates of Alzheimer’s disease should be revised upwards by at least 5 million cases (20 percent or more).
The Healthy China Action plan of 2019–2030 promotes the transition from disease treatment to health maintenance for this expanding population with ADRD. This report describes related epidemiological trends, evaluates the economic burden of the disease, outlines current clinical diagnosis and treatment status and delineates existing available public health resources.
The plan also addresses the public health impact of ADRD, including prevalence, mortality, costs, usage of care, and the overall effect on caregivers and society. In addition, this special report presents technical guidance and supports for the prevention and treatment of AD, provides expertise to guide relevant governmental healthcare policy development and suggests an information platform for international exchange and cooperation.
According to the Chinese census of 2020, individuals 60 years and above and those aged over 65 years totaled 264,018,766 and 190,635,280, accounting for 18.70 percent and 13.50 percent of the population, respectively. Compared with the 2010 census figures, China’s aging population grew faster, and the incidence rate, morbidity and mortality of diseases associated with ageing were significantly higher. Alzheimer’s disease (AD) incidence continues to increase, and its social and economic burden is magnifying, posing major medical and social problems that threaten China’s urban and rural residents.
According to a recent national cross-sectional study, China has 15.07 million individuals aged 60 years and over with dementia, including 9.83 million with AD, 3.92 million with vascular dementia and 1.32 million with other forms of dementia. In addition, the prevalence of mild cognitive impairment (MCI) in those over 60 years of age is 15.5%, with 38.77 million individuals affected by it. A national study showed that the 2015 annual treatment cost of patients with AD in China was US$167.74 billion, with ever-rising treatment costs expected to reach US$1.8 trillion by 2050. However, the country’s diagnosis and treatment rate for AD remains low, with few medical specialists and minimal public awareness. Therefore, improving the prevention and treatment of AD under the government’s leadership is urgent.
The China Alzheimer Report 2022 was designed to support the implementation of the Healthy China Action plan (2019–2030), provide effective measures to prevent and slow the occurrence of AD, reduce the burden on families and society and respond to WHO recommendations.
The report specifically describes epidemiological trends, evaluates the economic burden of disease, outlines current clinical diagnosis and treatment status and delineates existing public health available resources for AD and related dementias (ADRD). In addition, this special report presents technical guidance and supports for the prevention and treatment of AD, provides expertise to guide relevant governmental healthcare policy development and suggests an information platform for international exchange and cooperation. Finally, it strives to align with international standards regarding ADRD while addressing issues specific to China.
The burden of disease data for ADRD was collected from the 2019 China provincial section of the global burden of disease (GBD) research. The GBD used multiple data sources and adopted a unified and comparable method to comprehensively analyze the burden of disease in countries or regions worldwide from 1990 to 2019. The death data mainly were taken from the cause of death monitoring in the China Disease Surveillance Point System and the cause of death registration report information system of the Chinese Center for Disease Control and Prevention. Prevalence data in China is derived from relevant surveillance, large-scale surveys, and systematic reviews of published literature. Other important data sources included the monitoring of chronic diseases and their risk factors in China, the survey of Chinese residents’ nutrition and health status and the national health service survey.
A previous study showed that 70 percent of persons with dementia in China has Alzheimer’s Disease.
In total, the prevalence and death rate of ADRD were slightly higher than the global levels, and the data reflected higher rates for women than those for men. By gender, the prevalence rate (1188.9/100 000) and the death rate (30.8/100 000) of females were respectively higher than the prevalence rate (669.3/100 000) and death rate (14.6/100 000) of males. Interestingly, a pilot study in Shanghai using hospital-based samples reported a similar survival trend of patients with AD compared with that of the general population. Poor cognitive status and comorbid diabetes had a negative impact on the survival of patients with AD, and a noteworthy association between AD and specific types of cancer was observed in China.
In 2019, the top five causes of death in China were cerebrovascular diseases, ischemic heart diseases, chronic obstructive pulmonary diseases, lung cancer and AD, respectively. In the past 30 years, the ranking of AD deaths in China rose from 10th in 1990 to 5th in 2019. The disease burden of ADRD in China from 1990 to 2019 rose from 27th to 15th.
In 2019, deaths due to ADRD worldwide reached 1,623,276. China contributed 320,715 deaths or 19.8 percent of the world total. ADRD prevalence worldwide compared with that in China.
In 2019, there were 51,624,193 individuals with ADRD in the world. In China, the number of patients with ADRD was 13,143,950, accounting for about 25.5 percent of global prevalence.
In 2019, provinces and municipalities with higher crude ADRD death rates were mainly concentrated in coastal cities, such as Shanghai Municipality (34.0/100 000), Chongqing Municipality (32.1/100 000), Jiangsu Province (31.1/100 000) and Zhejiang Province (30.1/100 000). The ADRD death rates in Northeastern China and parts of Central China were relatively low.
Treating Alzheimer’s Disease With Traditional Chinese Medicine
Recent studies showed positive effects on AD from tradition Chinese medicine, including traditional Chinese medicine and innovative Chinese compounds. An increasing number of Chinese traditional herbal medicines, including Liuweidihuang capsules, Taisi capsules, Bushenyijing granules, Yizhi decoction and Wujiayizhi granules, have been introduced to clinical trials in the past 2 years. Acupuncture, one of the most representative non-pharmaceutical treatments in traditional Chinese medicine, has attracted increasing attention recently due to its effectiveness and few side effects. A 28-week controlled study indicated that acupuncture could improve cognition and global clinical status in patients with mild-to-moderate AD.72 Two clinical studies, Sanlian Xingshen Yizhi Acupuncture therapy and acupuncture combined with donepezil, are ongoing to evaluate the efficiency and safety of acupuncture on AD.
In one clinical trial, folic acid combined with vitamin B12 showed a positive therapeutic effect on cognition in patients with AD. Preclinical evidence suggested sulforaphane has a multifaceted neuroprotective effect on brain health. A randomized, double-blind, placebo-controlled study was carried out to study the efficacy and safety of sulforaphane in patients with prodromal to mild AD. In another clinical study, the antipsychotic amisulpride was used to relieve the neuropsychiatric symptoms of patients with AD. Music therapy combined with strong light therapy was found to improve sleep quality for those with sleep disorders. Non-pharmaceutical interventions, such as music therapy, cognitive interventions, aerobic exercise and diet therapy, have fewer side effects and may provide promising therapeutic options for patients with AD.
In response to the appeal of a national program called Healthy China Action, the General Office of the National Health Commission issued a document on how to explore more effective prevention and treatment service for patients with AD in August 2020. It aims to accelerate establishing a public service system with Chinese characteristics to explore an integrated intervention mode. In the future, the treatment of AD in China would include comprehensive management based on the patients’ life span cycle, including specific disease-modifying medications, treatment of comorbidities, early interventions for risk factors and changes in personal lifestyles.
In recent years, the aging of the world’s population has intensified, and with it, the elderly population in China has grown significantly, showing a trend of accelerated increase. Along with this increase in ageing, the number of older adults with cognitive impairment is expanding rapidly. Surveys show that from 2010 to 2020, the proportion of people aged 60 years and above in China increased from 13.26 percent to 18.70 percent. WHO predicts that the proportion will rise to 28 percent by 2040.
Memory clinics have been established to diagnose, identify and treat patients with cognitive impairment (represented by AD) early in the course of illness while also providing nursing education for families and training for caregivers. The memory clinics offer patients timely professional diagnosis and treatment. Moreover, they have become medical units for clinical diagnosis and treatment with essential functions such as health education and chronic disease monitoring
Beginning the 1990s, neurology, psychiatry and geriatric departments of hospitals in large-sized and medium-sized cities in China have successively opened memory clinics; the names of these clinics have changed from the original dementia clinic or Alzheimer’s disease clinic to the present term, memory clinic. By 2014, 128 memory clinics had been opened in China. Since 2018, 26 medical institutions in Shanghai have opened memory clinics, including 11 comprehensive tertiary hospitals, eight mental health specialty institutions and seven primary community health service centers.
The 2019 China Alzheimer’s Disease Patients Family Survival Status Survey Report showed that the general population’s AD awareness had increased significantly in recent years. When symptoms of amnesia occur, >50 percent of individuals and their family members suspect AD in the affected party. The patients’ consultation rate within one year rose from 32.47 percent in 2012 to 77.43 percent, and timely consultation rates greatly improved. By 2019, 28.12 percent of all patients with AD were diagnosed in memory clinics; this high percentage reflects the vital role of memory clinics in the early detection and diagnosis of cognitive impairment disorders.
As the rate of population aging in China increases, the accompanying increased risk of cognitive impairment has led to an increased social risk. In the future, this social problem is likely to escalate. The government and society are paying increasing attention to cognitive impairment disorders such as AD. In the Healthy China 2030 plan, the Chinese government has proposed to ‘improve effective interventions for diseases such as AD’ and the public’s awareness of the prevention and treatment of AD in pilot areas will increase to 80 percent by 2022. It is necessary to establish and improve the Alzheimer’s disease prevention and treatment service network, especially since the screening rate of cognitive function among the older adults in the community is expected to increase to 80 percent. Additionally, it is essential to establish a multidisciplinary team providing diagnosis, treatment and nursing services for patients with MCI and dementia that includes general practitioners, volunteers, social workers, psychotherapists, and so on. In addition, the National Health Commission of the People’s Republic of China is conducting a study on the ‘Guidelines for Home Care of Older Adults with Dementia.
To reduce the occurrence of disability and dementia in the older adults at its source, in 2021, the National Health Commission of the People’s Republic of China issued the Notice on Pilot Programs for the Prevention and Intervention of Disability (Dementia) in Older Adults, which aims to carry out pilot programs in 13 provinces. Furthermore, they formulated the Technical Plan for the Pilot Prevention and Intervention of Disability (Dementia) among Older Adults. The Inner Mongolia Autonomous Region and Guangdong Province collaborated in this pilot project. Recently, intervention projects have been fully implemented in cities and districts of 15 intervention provinces.
Shanghai is a large city with the most rapidly aging population in China. It was one of the first cities to witness the increase in its aging population. In 2017, 170,000 older adults with dementia lived in Shanghai, accounting for 6.7 percent of older adults with registered permanent residences in Shanghai. The Shanghai government’s strategies for dealing with dementia are relatively advanced compared with the rest of the country.
Until recently, few have considered the possibility that Alzheimer’s disease is a transmissible disease. This denial and misinformation has been fueling a public health crisis around the world for years.
Dr. Stanley Prusiner, an American neuroscientist from the University of California at San Francisco, earned a Nobel Prize in 1997 for discovering and characterizing prions and prion disease. President Obama awarded Prusiner the National Medal of Science in 2010 to recognize the importance of his research. Important reforms to policies to protect public health, however, have been elusive. Prusiner confirmed that Alzheimer’s disease is a prion disease–also known as transmissible spongiform encephalopathy (TSEs). The operative word is “transmissible.”